In today’s Wall Street Journal, former NY Lt. Gov. Betsy McCaughey takes a closer look at Dr. Ezekiel Emanuel, Obama’s Health Rationer-in-Chief:
Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.
We’ve been told repeatedly by the President that enacting his healthcare reform plan is necessary to control runaway healthcare costs. Dr. Emanuel admits such claims are mere PR window dressing:
Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): “Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely ‘lipstick’ cost control, more for show and public relations than for true change.”
True reform, he argues, must include redefining doctors’ ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the “overuse” of medical care: “Medical school education and post graduate education emphasize thoroughness,” he writes. “This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath’s admonition to ‘use my power to help the sick to the best of my ability and judgment’ as an imperative to do everything for the patient regardless of cost or effect on others.”
There’s the rub. Emanuel apparently views the Hippocratic Oath through the same prism Obama that views the U.S. Constitution, which he disparagingly characterized as “a charter of negative liberties.” Here’s an example of what Emanuel’s vision of an “improved” Hippocratic oath would promote:
In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient’s needs. He describes it as an intractable problem: “Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs.” (JAMA, May 16, 2007).
Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained “to provide socially sustainable, cost-effective care.” One sign of progress he sees: “the progression in end-of-life care mentality from ‘do everything’ to more palliative care shows that change in physician norms and practices is possible.” (JAMA, June 18, 2008).
Note the deployment of intentionally imprecise Orwellian language: the alleged progression from a “do everything” mentality to ostensibly more palliative care. In plain English, Emanuel seeks to radically redefine the physician-patient relationship. Instead of serving the best interests of the patient, the progressive physician (or some faceless bureaucrat) will balance the needs of the patient against the needs of the collective. Per Emanuel’s own words, there’s little doubt who will be the winners and losers of this utilitarian calculus:
Dr. Emanuel argues that to make such decisions, the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: “Substantively, it suggests services that promote the continuation of the polity—those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations—are to be socially guaranteed as basic. Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia.” (Hastings Center Report, November-December, 1996)
In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a “complete lives system” for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. “One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.
It all sounds quite reasonable as long as you disregard actual examples of governments that implemented such progressive ideas.
“However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear.” In fact, Dr. Emanuel makes a clear choice: “When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated.”
As Orwell wrote in another context, “All animals are equal, but some are more equal than others.”
The 5th Century B.C. author of the Hippocratic oath wrote: “Whenever a doctor cannot do good, he must be kept from doing harm.” That’s still good advice. Under Emanuel’s version of ObamaCare, will doctors be kept from doing good?